Guide: costs

Free household help: when does insurance pay?

Free household help is possible for many people in Germany because the long-term care fund (Pflegekasse) or the health insurance fund (Krankenkasse) covers the costs. Here you will find all five routes at a glance, with the requirements and the cases where you still pay a share yourself.

By Alexander Sperling · Updated: 6 October 2026 · 9 min read

The team of Alltagsdienst Sperling in the foyer of the head office

Household help: which costs does insurance cover?

Two different funds can pay for household help. The long-term care fund pays if you have a care level (Pflegegrad). The health insurance fund pays in particular situations, for example after surgery, during a serious illness or in pregnancy, even without a care level.

Alltagsdienst Sperling is recognised on both sides: under state law as a provider of everyday support services (Angebot zur Unterstützung im Alltag) and as an approved domestic help service with all statutory health insurance funds. That is why we bill your fund directly, with all 93 statutory health insurance funds (as of July 2026). In most cases this means no share to pay and no paperwork for you. Where you do have to pay something, we tell you openly beforehand.

Several of the following five routes can be combined.

Relief allowance: 131 euros a month from care level 1

Anyone with a care level, whichever it is, is entitled to the relief allowance (Entlastungsbetrag) under § 45b SGB XI. It amounts to 131 euros a month and is earmarked: you use it for recognised everyday support services, such as help with cleaning, laundry and shopping or being accompanied to appointments. The money is not paid out in cash.

With us you do not need a separate application, as we bill your long-term care fund directly. Unused amounts are carried over to the following half-year, and whatever is left at the end of a year can be used until 30 June of the next year. After that it expires. How to make good use of saved-up amounts is explained in our article on saving and using the relief allowance.

Conversion entitlement: up to 40 per cent of the in-kind care benefit

From care level 2 you are entitled to the in-kind care benefit (Pflegesachleistung), a monthly budget for a home care service. If this budget is not used, or not fully used, by a care service, you can use up to 40 per cent of it for recognised everyday support services. This is the conversion entitlement (Umwandlungsanspruch) under § 45a (4) SGB XI. It comes on top of the relief allowance.

Care level 2: up to 318.40 euros a month
Care level 3: up to 598.80 euros a month
Care level 4: up to 743.60 euros a month
Care level 5: up to 919.60 euros a month

If you also receive care allowance (Pflegegeld), it is reduced proportionately (combination benefit, Kombinationsleistung). Many care funds want to be informed in advance. We are happy to work out with you in a free consultation whether conversion makes sense for you. The topic is explained in detail in our article on the conversion entitlement of 40 per cent. The planned Care Reorganisation Act is to restructure long-term care benefits as a whole. We will update this article once the act has been passed.

Respite care: hourly relief from care level 2

If relatives provide care at home and need a break, fall ill or go on holiday, respite care (Verhinderungspflege) steps in. Since 1 July 2025 there has been a joint annual budget (Gemeinsamer Jahresbetrag) of up to 3,539 euros per calendar year from care level 2 (§ 42a SGB XI). You can split it freely between respite care and short-term care (Kurzzeitpflege). The former requirement of six months of prior care no longer applies.

Respite care is possible for up to eight weeks a year. Hourly respite care is a particularly good fit: if it is used for less than eight hours a day, it does not count towards the eight weeks and does not reduce the care allowance. Our support worker then steps in for a few hours, and we bill the long-term care fund. How this works in everyday life is explained in our article on hourly respite care. Changes are planned here too, see the note on the relief allowance.

Household help from health insurance: illness and pregnancy

After surgery or during serious illness (§ 38 SGB V)

If you cannot keep your household running because of a serious illness or an acute worsening of an illness, your health insurance fund covers household help. This applies especially after a hospital stay, after outpatient surgery or after outpatient hospital treatment. The condition is that no one else living in the household can keep it running.

Duration: up to 4 weeks. If a child under 12 or a disabled child who depends on help lives in the household, up to 26 weeks.
Without a child in the household, the entitlement only applies if you do not have care level 2 to 5.
You need a medical certificate and an application to your health insurance fund, ideally before the help starts.
Adults aged 18 and over pay a co-payment (Zuzahlung), see below. Some funds offer more under their statutes.

You will find all the details on our page about household help after surgery.

During pregnancy and after giving birth (§ 24h SGB V)

Your health insurance fund also pays if you cannot keep the household running because of pregnancy or childbirth and no one else in the household can step in. Typical situations are premature labour, medically prescribed bed rest, a high-risk pregnancy or the time after giving birth, including after a caesarean section. There is no co-payment and no fixed maximum duration: the help continues for as long as a doctor certifies the need. You need a medical certificate and an application to your health insurance fund, and we then bill the fund directly. Read more on our page about household help during pregnancy.

When free household help is not entirely free

In most cases you pay nothing towards our help. But there are situations where you pay a share or where money is missing elsewhere:

Co-payment for illness: For household help under § 38 SGB V, adults aged 18 and over pay 10 per cent of the daily costs, at least 5 and at most 10 euros per day (§ 61 SGB V). There is no co-payment during pregnancy.
More hours than your entitlement: If you need more help than the fund pays for, you can book extra hours privately. We discuss the cost with you beforehand.
Less care allowance: If you use the conversion entitlement, any care allowance you receive at the same time is reduced proportionately. This is not a share you pay, but it is money that is missing elsewhere.
Private insurance: Whether and how much is covered depends on your policy. We advise you individually.

Without a care level and without a reason such as surgery, a serious illness or pregnancy, health and care funds generally do not pay for household help.

Which route is right for me?

A first overview. We are happy to clarify your exact entitlement with you.

Care level 1: relief allowance of 131 euros a month, with us without a separate application.
Care level 2 to 5: relief allowance, plus the conversion entitlement and, if relatives provide care, the joint annual budget for hourly respite care.
After surgery or during serious illness: household help from your health insurance fund under § 38 SGB V, with a co-payment. Without a child in the household only if you do not have care level 2 to 5.
During pregnancy or after giving birth: household help from your health insurance fund under § 24h SGB V, without a co-payment.
No care level yet, but help needed in the long term: first apply for a care level with the long-term care fund. A phone call is enough, and benefits apply from the month of application.

Not sure? Call us on 07121 159 10 58, Monday to Friday from 08:00 to 14:00. Outside these hours our AI phone assistant Vera takes your request. In a free initial call we clarify which entitlement applies and help you with all the applications you need.

Frequently asked questions

Is household help with a care level really free?

In most cases yes, as long as the hours stay within your entitlement. We bill your long-term care fund directly. If you need more hours, you can add them privately.

How many hours of household help does the care fund pay for?

That depends on your care level and the routes you use. From care level 2, the conversion entitlement can be added to the relief allowance, which means considerably more hours. In a free initial call we work out how many hours your entitlement covers.

Do I need to apply?

Not for the relief allowance, as we bill your long-term care fund directly. For the conversion entitlement, many care funds want to be informed in advance. For household help from your health insurance fund you need a medical certificate and an application. We help you with every application.

Can I combine several routes?

Partly, yes. From care level 2 you can use the relief allowance, the conversion entitlement and the joint annual budget side by side. Household help under § 38 SGB V, on the other hand, is only available without a child in the household if you do not have care level 2 to 5.

Does private insurance pay as well?

That depends on your policy. If you are privately insured, your care level is assessed by Medicproof rather than by the Medical Service (Medizinischer Dienst). We are happy to advise you individually.

Sources

This article reflects the legal situation on the date given and is not legal advice. We review the amounts every year at the turn of the year.